MedicaidCoverageHigh impact
Newsletter Vol. 3, No. 33
New Jersey Medicaid·NJ · Pathology·Medical Policy
We identified it
Jun 20, 2026
Summary
Beginning August, Medicaid will deny all laboratory claims submitted by independent clinical laboratories that have not obtained a CLIA (Clinical Laboratory Improvement Amendments) certificate and identification number. Providers must be CLIA-certified and enrolled before submitting claims for laboratory services performed after September to receive Medicaid reimbursement.
Action Required
Before August implementation: (1) Billing team must verify that all independent clinical laboratory providers have obtained and registered their CLIA certificate and identification number in the billing system. (2) Update billing software to require CLIA certificate verification before processing Medicaid claims for laboratory services. (3) Add validation rule to deny/reject claims from non-CLIA-certified providers and generate internal alerts. (4) Notify all laboratory providers to confirm CLIA enrollment status; non-enrolled providers should contact HCFA CLIA Program (PO Box, Baltimore, MD) immediately. (5) Do NOT attempt to collect payment directly from Medicaid recipients for denied claims. Consequence: Claims from uncertified providers will be systematically denied by Medicaid, resulting in revenue loss and potential compliance violations. Federal government may seek criminal sanctions for intentional CLIA violations.